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The ambulance siren can be heard quite clearly in a traffic jam at Hotel Metropole. At a desk in a control room across the city sits an attendant advising the ambulance driver to remain patient and keep sounding the siren. The road starts clearing up eventually and the big yellow Toyota Hiace makes its way out of the rush. Watching the ambulance moving on his computer screen again, the desk operator guides its driver to take the shortest route to the hospital. Quickly he turns to the wrong side of Shahra-i-Faisal to drive straight to the hospital on the one-way road. And that’s how the Aman ambulance saves a life that day.

Karachi’s life-saving Aman ambulance service came about some three-and-a-half years ago by the NGO, Aman Foundation, after feeling a grave need for it. “There is no shortage of ambulances in the city but a majority of them are used to transport the sick or injured from one point to the other. There was a need for an ambulance service that could deal with trauma patients in road accidents, cardiac arrests and, with crime on the rise in Karachi, gunshot wounds, too,” says Dr Junaid Razzak, CEO Health at Aman Foundation.

“The Aman ambulance service is the vision of our Founder, Trustee and Chairman Arif Naqvi. We have 100 ambulances in Karachi only, 80 of which are operating while 20 are kept as backups. They are all Toyota Hiace vans as the life-saving equipment fits in a van this big. The other option would have been a box like trailer attachment on a pickup truck chassis but the van seemed more practical,” points out the doctor, who has training in emergency medicine from the Yale New Haven Hospital in USA and holds a PhD in Public Health from the Karolinska Institute in Sweden.

Ambulances are traditionally white in colour but the Aman ambulance is yellow. “Well, the concept is for the vehicle to stand out from the rest and florescent yellow is as visible as white,” says Dr Razzak before explaining that though they may look identical from the outside, the Aman ambulances are of two kinds basically. “There is the Advance Life Support (ALS) and the Basic Life Support (BLS) ambulance. The ALS ambulance has a doctor and paramedic along with the driver while the BLS ambulance has an emergency medical technician, a paramedic and a driver. Our drivers, by the way, also have complete paramedic training in CPR and life support,” he adds.

“After sending our personnel for training with Rescue 1122 in Punjab, Aman Foundation, seven months ago, opened its own paramedic training academy where we train our paramedics in a six-month diploma course in batches of 25. Meanwhile, refresher courses are ongoing. We also gather for once-a-week discussions about how a difficult case was managed for the others to learn from it. Each death on an ambulance is also reviewed with feedback given to the management,” he informs.

“We receive around 1,100 to 1,200 calls every day on our emergency ‘1021’ number. We have a medical priority dispatch system in place to handle all the calls. The person who receives a call, then follows the Asking Questions and Understanding Answers (AQUA) system where he or she will ask a set of standard questions in order to judge the severity level of the patient. He then passes that information to the computer wireless operator to send the right kind of ambulance for the patient,” he explains.

“Of the calls we receive, our performance monitoring team is randomly listening in on 400 to 430 calls,” he shares. “There are a total of 20 people working in three shifts in our control room, which has data and reporting desks, tracking charges, trainers, evaluators, etc. besides the emergency call takers,” he informs.

“We have divided Karachi into two zones. Zone one has four stations and Zone two five. And each station has nine to 10 key points where the ambulances wait. All ambulances have a Global Positioning System (GPS) for monitoring, command and control,” he says.

“Half of our work is inter-hospital transportation of patients who need special care. The flat charge at present is Rs200 but we are planning on coming up with a tiered structure that charges more from those who can afford it,” says the doctor.

“We are, on average, spending Rs3,000 per patient including the human resource being used, the vehicle fuel and other things,” he justifies the plan. “We also need more local and foreign funding agencies to help us carry on with our work. We would like to expand to the rest of Sindh, too, for which we need to engage help from the government as well, as the Punjab, Khyber Pakhtunkhwa and Gilgit-Baltistan governments support Rescue 1122,” he concludes. — Shazia Hasan